Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Caracterização de idosos diabéticos atendidos na atenção secundária Characterization of elderly diabetics receiving secondary care

Caracterizou-se os idosos diabéticos segundo as variáveis sociodemográficas e econômicas e descreveu-se as condições de saúde, capacidade funcional e utilização dos serviços de saúde, relacionando-as com o tempo de diagnóstico de diabetes, almejando-se contribuir para o planejamento das intervenções de saúde dessa área. A amostra populacional foi obtida através do atendimento de diabéticos nos três serviços de endocrinologia de Uberaba (MG), no período de um ano. Entrevistaram-se 113 idosos diabéticos, no domicílio. Para análise, utilizou-se distribuição de freqüência simples, medidas descritivas e as associações foram estudadas através do teste chi&sup2; (p < 0,05). São do sexo feminino 72,6% dos sujeitos; com idade média de 69 anos (&plusmn; 4,6). O maior percentual do tempo de diagnóstico (51,3%) está na faixa de 10 -| 20 anos. Todos apresentam outro problema de saúde além do diabetes. Os maiores percentuais para dependência, identificados através da capacidade funcional, foram: cortar unhas dos pés (23,9%) e usar transporte (18,6%). O tempo de diagnóstico não se constituiu em agravante para a dependência do idoso. Contudo, a dependência no envelhecimento está presente e se constitui em desafio para os profissionais de saúde.<br>The purpose of this survey is to characterize elderly diabetics by social, demographic and economic variables, describing their health status, functional capacity and use of healthcare services, related to the time when diabetes was diagnosed, in order to contribute to future healthcare planning actions in this area. The population sample was obtained through the diabetes services at three endocrinology units in Uberaba, Minas Gerais State in the course of a year, interviewing 113 elderly diabetics at home. The simple frequency distribution was used for the analysis, together with descriptive measurements. Associations were studied through chi&sup2; (p< 0.05) test; 72.6% of the respondents were women with average age of 69 years (&plusmn; 4.6). The longest times since diagnosis (51.3%) are between ten and twenty years. All the respondents presented other health problems in addition to diabetes. The main aspects of dependence identified through functional capacity were: trimming toenails (23.9%) and use of transportation (18.6%). The time since diagnosis was not an aggravating factor for dependence among these elderly diabetics. However, dependency during the aging process is present, offering a challenge to healthcare practitioners